Gräf M.

University of Gießen, Department of Ophthalmology, Strabismology and Neuroophthalmology, Friedrichstrasse 18, D - 35385 Gießen

The term nystagmus describes rhythmical oscillations of the eyes. Nystagmus occurs as a physiological response to optokinetic or vestibular stimuli, purposing the stabilization of the retinal image. Spontaneous nystagmus is always pathological and requires skillful diagnosis whereby classification of the nystagmus with regard to the following criteria is helpful: Is the nystagmus congenital or acquired, dissociated or non-dissociated, conjugate or disconjugat, pendular or jerky, spontaneous or induced, active in primary gaze or only in eccentric gaze? Further distinguishing features are the plane in which the nystagmus acts (horizontal, vertical or torsional), the presence and position of a neutral-zone, and the relationship between the direction of the nystagmus and both the gaze direction and the fixing eye. Associated findings like hypacusis, oscillopsia, vertigo, nausea, amblyopia, and ocular disorders causing a sensory nystagmus by a disturbance of normal fixation (e.g., congenital cataract, aniridia, albinism, rod monochromacy) have to be considered. In the evaluation of congenital nystagmus and latent type nystagmus, the acquisition of neuroimaging studies is not necessary, if the child is otherwise neurologically normal. In the case of a sensory nystagmus, causal or associated disorders have to be excluded. Regarding the indication of eye muscle surgery for abnormal head posture or general damping of the nytagmus, it is decisive whether either a certain version innervation or convergence innervation or both a certain version innervation and convergence damp the nystagmus. Particularly regarding Kestenbaum surgery, latent type nystagmus has to be clearly differentiated from congenital nystagmus, and alternating nystagmus has to be ruled out.

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